dysmenorrhea

Menstruation, or period, is normal vaginal bleeding that happens as part of a woman's monthly cycle. Many women have painful periods, also called dysmenorrhea. The pain is most often menstrual cramps, which are a throbbing, cramping pain in your lower abdomen. You may also have other symptoms, such as lower back pain, nausea, diarrhea, and headaches. Period pain is not the same as premenstrual syndrome (PMS). PMS causes many different symptoms, including weight gain, bloating, irritability, and fatigue. PMS often starts one to two weeks before your period starts.

There are two types of dysmenorrhea: primary and secondary. Each type has different causes.

Primary dysmenorrhea is the most common kind of period pain. It is period pain that is not caused by another condition. The cause is usually having too many prostaglandins, which are chemicals that your uterus makes. These chemicals make the muscles of your uterus tighten and relax, and this causes the cramps.

The pain can start a day or two before your period. It normally lasts for a few days, though in some women it can last longer.

You usually first start having period pain when you are younger, just after you begin getting periods. Often, as you get older, you have less pain. The pain may also get better after you have given birth.

Secondary dysmenorrhea often starts later in life. It is caused by conditions that affect your uterus or other reproductive organs, such as endometriosis and uterine fibroids. This kind of pain often gets worse over time. It may begin before your period starts and continue after your period ends.

To help ease your period pain, you can try:

• Using a heating pad or hot water bottle on your lower abdomen
• Getting some exercise
• Taking a hot bath
• Doing relaxation techniques, including yoga and meditation

You might also try taking over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen and naproxen. Besides relieving pain, NSAIDs reduce the amount of prostaglandins that your uterus makes and lessen their effects. This helps to lessen the cramps. You can take NSAIDs when you first have symptoms, or when your period starts. You can keep taking them for a few days. You should not take NSAIDS if you have ulcers or other stomach problems, bleeding problems, or liver disease. You should also not take them if you are allergic to aspirin. Always check with your health care provider if you are not sure whether or not you should take NSAIDs.

It may also help to get enough rest and avoid using alcohol and tobacco.

For many women, some pain during your period is normal. However, you should contact your health care provider if:

• NSAIDs and self-care measures don't help, and the pain interferes with your life
• Your cramps suddenly get worse
• You are over 25 and you get severe cramps for the first time
• You have a fever with your period pain
• You have the pain even when you are not getting your period

To diagnose severe period pain, your health care provider will ask you about your medical history and do a pelvic exam. You may also have an ultrasound or other imaging test. If your health care provider thinks you have secondary dysmenorrhea, you might have laparoscopy. It is a surgery that that lets your health care provider look inside your body.

If your period pain is primary dysmenorrhea and you need medical treatment, your health care provider might suggest using hormonal birth control, such as the pill, patch, ring, or IUD. Another treatment option might be prescription pain relievers.

If you have secondary dysmenorrhea, your treatment depends upon the condition that is causing the problem. In some cases, you may need surgery.

A cervix disorder is a problem with your cervix. The cervix is part of the female reproductive system. It is the lower, narrow end of the uterus (womb), which opens into the vagina (birth canal). The cervix has a small opening that expands during childbirth. It also allows menstrual blood to leave your body.

You may not have any symptoms of a cervix disorder, but routine pelvic exams and a Pap smear test can help determine if you may need treatment.

Cervix disorders can include:

• Cervical cancer is a cancer that starts in the cells of the cervix.
• Cervicitis is swelling of the cervix. An infection usually causes it, but it can also be caused by skin irritation. Treatment can help you avoid potential complications like pelvic inflammatory disease (PID).
• Cervical incompetence (also called cervical insufficiency) can happen during pregnancy. The opening of your cervix widens too early. This may cause you to give birth too soon, or you could lose the fetus.
• Cervical polyps and cysts are fleshy or fluid-filled growths on your cervix. These growths are usually benign (not cancer). They are more common during your reproductive years, especially after age 20.

You are more likely to develop a cervix disorder if:

• You've had a previous cervical procedure or surgery.
• You've had a sexually transmitted infection (STI) such as chlamydia or gonorrhea.
• You used a latex condom or a feminine product such as a spermicide or douche that irritated the skin of your vagina.
• You left something in your vagina too long, such as a diaphragm, tampon, or cervical cap, and it caused irritation.
• You don't consistently use a condom when you have sex, or you have multiple sex partners.

You may not know that something is wrong since cervix disorders may not have any symptoms. If you have symptoms, they may vary based on the cervix disorder.

Symptoms can include:

• Vaginal bleeding that's not normal for you, such as bleeding between menstrual periods
• Pain during sex or a pelvic exam
• Abnormal vaginal discharge

If you are pregnant, a few signs of an incompetent cervix could include light vaginal bleeding, a feeling of pelvic pressure, or mild cramps. But you may not have any signs.

Even if you don't have symptoms, your health care provider may notice changes to the cells of your cervix during a pelvic exam. Your provider may look for:

• Redness or inflammation (swelling) of your cervix or vaginal walls
• Vaginal discharge or strong odor

Your provider may perform a Pap test to look for changes in your cervix.

The treatment for cervix disorders depends on the cause. It might include antibiotics or stopping using a product that causes skin irritation.

If you have had an incompetent cervix in the past, you might take medicine or have ultrasound imaging tests to check how your pregnancy is going.

You can take steps to prevent some cervix disorders. This can include to:

• Use a condom every time you have sex. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STIs. If you or your partner is allergic to latex, you can use polyurethane condoms.
• Have regular pelvic exams.
• Get tested for STIs as needed.
• Avoid using personal care products that may cause skin irritation to your vagina.

Gonorrhea is a sexually transmitted infection (STI). It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth.

Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles.

In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility.

Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. If your or your partner is allergic to latex, you can use polyurethane condoms. The most reliable way to avoid infection is to not have anal, vaginal, or oral sex.

Centers for Disease Control and Prevention

Menstruation, or period, is normal vaginal bleeding that occurs as part of a woman's monthly cycle. Every month, your body prepares for pregnancy. If no pregnancy occurs, the uterus, or womb, sheds its lining. The menstrual blood is partly blood and partly tissue from inside the uterus. It passes out of the body through the vagina.

Periods usually start between age 11 and 14 and continue until menopause at about age 51. They usually last from three to five days. Besides bleeding from the vagina, you may have:

• Abdominal or pelvic cramping pain
• Lower back pain
• Bloating and sore breasts
• Food cravings
• Mood swings and irritability
• Headache and fatigue

Premenstrual syndrome, or PMS, is a group of symptoms that start before the period. It can include emotional and physical symptoms.

Consult your health care provider if you have big changes in your cycle. They may be signs of other problems that should be treated.

NIH: National Institute of Child Health and Human Development

Pain is a signal in your nervous system that something may be wrong. It is an unpleasant feeling, such as a prick, tingle, sting, burn, or ache. Each person feels pain differently, even if the reason for the pain is the same. Pain may be sharp or dull. It may be mild or severe. Pain may come and go, or it may be constant. You may feel pain in one area of your body, such as your back, abdomen, chest, or pelvis, or you may feel it all over.

Pain can help alert you that there is a problem. If you never felt pain, you might seriously hurt yourself without knowing it, or you might not realize you have a medical problem that needs treatment. Finding out what's causing your pain will help your health care provider determine the best way to manage or treat it.

Patterns and types of pain are named based on how long and how often you have pain. These include:

• Acute pain usually happens suddenly because of a disease, injury, or inflammation (irritation, redness, and/or swelling). This type of pain is often sharp and acts as a warning that something is wrong. It usually goes away when the cause is treated or healed, though sometimes it can turn into chronic pain. Some examples of causes of acute pain include broken bones or dental issues.
• Chronic pain lasts for longer than three months or the time in which you should have healed. It can affect all aspects of daily life, including your mood and relationships. Some conditions that might cause chronic pain include arthritis or back problems.
• Episodic pain can happen from time to time and may occur with long-term medical conditions. Some conditions that might cause episodic pain include sickle cell disease or chronic migraines.

Pain may also be categorized by what is likely to be the cause of the pain. Pain may be described as nociceptive (caused by tissue damage or inflammation), neuropathic (caused by nerve damage), or nociplastic (caused by changes in how your nervous system processes pain).

Understanding what causes pain and why people feel it differently may be difficult. Often, it's easier to find the cause of acute pain due to an injury than the cause of chronic pain, or you may have an ongoing cause of pain, such as cancer.

In some cases, there is no clear cause. Environmental factors and psychological factors such as stress and beliefs about pain may affect the way you feel pain and respond to treatment.

You are the only one who knows how your pain feels. Your provider can best measure your pain by how you report it. They may ask you:

• Where is the pain in your body?
• How long have you had the pain?
• How does the pain feel, such as stinging, burning, or sharp?
• How often do you have pain?
• When do you feel pain, such as in the morning, evening, or all the time?
• What relieves the pain?
• How does pain affect your daily life?
• Is the pain mild, moderate, or severe?
• To rate the pain on a scale.

If the cause of your pain is unknown, your provider may also do a physical exam and order blood tests or other medical tests to help find the cause.

Pain is not always curable, but there are many ways to manage and treat it. Treatment depends on the cause and type of pain. Treatments may include medicines, such as pain relievers. There are also non-drug treatments, such as acupuncture, physical therapy, and sometimes surgery.

Depending on the cause of your pain and your symptoms, your provider may recommend lifestyle changes. These may include suggestions for:

• Eating a healthy diet
• Adding exercise
• Losing weight
• Managing stress
• Improving mental health

NIH: National Institute of Neurological Disorders and Stroke